Ventriculostomy Practice on a Library of Virtual Brains Using a VR/Haptic Simulator Improves Simulator and Surgical Outcomes

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Slide 1

Ventriculostomy Practice on a Library of Virtual Brains Using a VR/Haptic Simulator Improves Simulator and Surgical Outcomes

Rachel Yudkowsky MD MHPE
Graham Clinical Performance Center
Dept of Medical Education
University of Illinois at Chicago

Image: A photograph shows ungloved hands performing virtual brain surgery using a surgical simulator.

Slide 2

• Cristian Luciano.
• Pat Banerjee.
• Ali Alaraj.
• Michael Lemole.
• Alan Schwartz.
• Fady Charbel.
• Kelly Smith.
• Silvio Rizzi.

University of Illinois at Chicago
Graham Clinical Performance Center
College of Medicine
College of Engineering
Institute for Patient Safety Excellence

Slide 3

This project was supported in part by a grant from the Agency for Healthcare Research and Quality to Dr. Yudkowsky.

The opinions expressed in this presentation are those of the authors and do not reflect the official position of AHRQ or the U.S. Department of Health and Human Services.

Disclosures
Drs Banerjee and Charbel: Owners/Partners in Immersive Touch Inc
Dr Luciano: Consultant to Immersive Touch Inc

Slide 4

Ventriculostomy

Image: A drawing of a brain is shown. The lateral ventricle, third and fourth ventricles, and the cerebral aqueduct are labeled.

Slide 5

Component Skills

• Translate 2D CT images into 3D location and shape of ventricles.
• Aim probe correctly.
• Insert probe to correct depth.
• Perceive density transition into ventricle.

Slide 6

Immersive Touch®  Sensimmer ® Simulator

Image: A photograph shows the surgical simulator machine.

Slide 7

Image: A screenshot from the surgical simulator shows an open skull with the brain exposed for surgery. Above the main image are smaller images of the brain from transverse, sagittal, and coronal views.

Slide 8

Video

Slide 9

The trouble with task trainers…

• No clinical variation.
• No range of difficulties.

Slide 10

Image: Multiple screenshots from the surgical simulator show a number of sample brains—normal and hydrocephalic, shifted, and slit.

Slide 11

Would Ventriculostomy Practice on a Library of Virtual Brains Improve Simulator and Surgical Outcomes?

Image: The multiple screenshots from Slide 10 are repeated.

Slide 12

The intervention: Simulator Practice on 12 Virtual Brains

• View full CT scan.
• Attempt to insert catheter into brain, using pre-drilled burrhole.
• Check to see if successful.
• "Open" brain to see where the catheter tip ended up.

Slide 13

Simulator Pre/Post

• 3 attempts at each of 3 novel virtual brains:
  • Normal ventricle.
  • Slit ventricle.
  • Shifted ventricle.
• Different brains presented pre and post.
• Posttest brains presented at 1-month follow up.

Slide 14

Simulator Outcomes Generalized Linear Mixed Models (GLMM)

• Relative to pre-intervention performance, residents were more successful immediately post-intervention (OR=3.43, 95% CI=[1.74, 6.77], p<.001) as well as at follow-up (OR=2.59, 95% CI=[1.24, 5.41], p=.011).
• Performance at follow-up was significantly worse than immediately post-intervention (p<.001).

Slide 15

Live Surgery Pre/Post

• Data from live procedures collected for about 6 months before, 1 month after intervention.
  • Successful cannulation.
  • Success at first attempt.
  • Ipsilateral vs contralateral.
  • Lateral ventricle vs other space.
  • Hemorrhage.

Slide 16

Live Surgery Pre/Post
91 pre-practice, 47 post

• Success at first attempt:  82% pre vs 91% post practice.
  • OR=4.74, 95% CI=[1.10, 20.4], p=0.04.
• Correct lateral ventricle placement (vs 3rd ventricle) was more likely before practice.
  • OR=2.61, 95% CI=[1.20, 5.77], p=0.02.
• Hemorrhage 7%, NS.

Slide 17

Ventriculostomy

Image: A drawing of a brain is shown. The lateral ventricle, third and fourth ventricles, and the cerebral aqueduct are labeled.

Slide 18

Caution!

Is the simulator also teaching incorrect habits?
Lack of "soft-pass" capability

Slide 19

Cautious Conclusions

• Ventriculostomy practice on a library of virtual brains improves simulator and surgical outcomes.
  • Simulator provides unique immediate fb.
  • Library provides a range of clinical challenges and difficulty levels.

Slide 20

Next Steps

• Improve simulator.
• Embed in curriculum for beginning neurosurgery residents.
• →Just-in-time training for non-neurosurgeons?
• →Ultimate goal: practice on a projection of your own patient’s brain.

Slide 21

Thanks AHRQ!

Questions?